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Infection > Travel Related Infections > Flashcards

Travel Related Infections Flashcards

1
Q

What are travel related infections ?

A

They occur when a patient has travelled to another location which has a different set of common diseases - usually a location with a considerable climate difference or within the tropics.

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2
Q

Why is travel history taking important ?

A
  1. Better to catch it early on as treatable tropic infections can have time to develop complications as they are not considered in a differential diagnosis. By detecting early on we can prevent the spread through communities and hospital and allows for adequate treatment.
  2. It is important to be precise when establishing travel history as some countries have different strains of the same microorganisms whose prevalence may vary by the time of the year. These different strains may have differences in antibiotic or drug resistance.
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3
Q

What questions may be typically asked when taking travel history ?

A
  1. Any unwell companions / contacts
  2. Any pre travel vaccinations / preventative measures
  3. Any healthcare exposure ?
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4
Q

What is the commonest imported infection to the UK ?

A

Malaria - 1500 cases per year in the UK. Up to 11 death per year.

90% of cases are from Africa - caused by P.Falciparum. And remainder are vivax / ovale.

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5
Q

What species causes malaria ?

A

Caused by different species of the protozoan genus Plasmodium. There are many different species for this genus but only FIVE causes malaria in humans :

  1. Falciparum ( deadliest human parasite )
  2. Ovale
  3. Vivax
  4. Malariae
  5. Knowlesi

THESE PROTOZAL MICROORGANISMS ARE CARDIES BY THE FEMALE ANOPHELES MOSQUITO WHICH ACTS AS A VECTOR.

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6
Q

What is th incubation period for malaria ?

A

Each species presents with a different incubation period.

It is generally minimum 6 days.

With P.falciparum the incubation period is 4 weeks.
With P.Vivax /ovale the incubation period is up to 1 year +.

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7
Q

A patient with Malaria would present with what symptoms ?

A

High heart rate (110+)

Low blood pressure (95/70)

O2 saturation around 90%

Mild confusion

Bite / puncture marks

Hepatosplenomegaly

Vomiting and nausea

Headache

Fever chills & swears in cycles every 3rd/4th day

Muscular Fatigue and pain

Back pain

Dry cough

Severe cases often involve : Acute respiratory distress syndrome ( during treatment ),

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8
Q

Outline the life cycle of the P.falciparum

A
  1. A mosquito will bite someone with its proboscis
  2. The plasmodium moves from the mosquitos salivary gland and into the patients blood stream.
  3. When in the bloodstream , the plasmodium is in the SPOROZOITE STAGE.
  4. Once these sporozoites are in the bloodstream they go straight for the liver and get inside the liver parenchyma ( functional tissue)
  5. The P.falciparum then begin to multiply asexually in the liver and mature from sporozoites to MEROZOITES. Once they are ready they burst out from the liver and go straight to the bloodstream where they attack and enter RBC ( usually older ones )
  6. Now once the MEROZOITES enter the RBC , they begin to replicate asexually and mature over 2-3 days. When they are ready the mature MEROZOITES burst out of the RBC and the RBC is now called a SCHIZONT.
  7. The mature MEROZOITES can now go off to infect more RBC. This will cause splenomegaly , jaundice , haemolysis
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9
Q

What is a paroxysm fever ?

A

Fevers that occur in short bursts for example P.falciparum causes fever in a random cycle pattern eg every 3/4th day patient would present with fever.

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10
Q

With the destruction of RBC , a patient will present with what symptoms of haemolytic anaemia ?

A
  1. Pallor
  2. Jaundice
  3. Dark coloured urine because of the prescence of HB in urine
  4. Weakeness
  5. Dizziness and confusion

This would be typical of all five plasmodium infections expect P.falciparum.

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11
Q

How is malaria investigated ?

A

A thick and thin blood film ( 3x) to ptest for th prescient of parasites and then which specific parasite.

A full blood count is also ordered which would show a normocytic and normochromic anaemia.

It it also shows a low platelet count and an increase in lactate dehydrogenase then likely to diagnose malaria.

A head CT scan if neurological symptoms present.

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12
Q

What is the treatment of malaria ?

A

Treatment depends on the type of parasite.

A complicated case of malaria will need immediate parenteral antimalrial therapy with the drug called ARTSUNATE ( IV /IM). This is given alongside ( bottom drugs ).

For example P.Falciparum is treated with quinine and doxycycline.

Whereas P.Vivax / ovale / malariae is treated with chloroquine.

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13
Q

Why is chloroquine not used for treatment of P.falciparum?

A

Because there is widespread resistance to this drug

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14
Q

What are the 3 terms used to describe recurrent malaria ?

A
  1. Relapse ( patient is cleared of MEROZOITES but those dormant hypnozoites in the liver have decided to no longer be dormant )
  2. Reinfection ( the patient was properly cured of malaria but has now completely acquired a new infection )
  3. Recrudescence ( the treatment didn’t kill of parasite )

For relapse : give additional primaquine

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15
Q

How to prevent malaria ?

A

Assess risk : knowledge of risk areas.

Bite prevention : buy repellant , adequate clothing , sleep under nets. Chemoprophylaxis before travel.

Chemoprophylaxis : specific fo region and must start before and continue after return generally for 4 weeks

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16
Q

What is typhoid fever ( also called enteric fever ) caused by ?

A

Salmonella typhi ( rod shaped gram negative bacteria )

17
Q

WHat would a patient who has typhoid fever present with ?

A

Fever
Incubation period 7-14 days
Relative bradycardia
Diffuse abdominal pain

Constipation

If left untreated it could lead to GI haemorrhage , bowel perforation and delirium. This can lead to death a month post infection.

18
Q

Where is typhoid fever more common ?

A

In areas where there is poor sanitation and limited access to clean water.

Children are more likely to get typhoid fever than adults.

Mainly Asia , Africa and South America

19
Q

What is mechanism of infection of typhoid fever ?

A

Faecal-oral from contaminated food / water

20
Q

What are virulence factors of salmonella organisms ?

A
  1. Low infectious disease
  2. Survives gastric acid
  3. Fimbriae adhere to epithelium over Ileal lymphoid tissue
  4. Reside within macriphages in liver , spleen bone marrow
21
Q

How would you investigate enteric fever ?

A
  1. Check for moderate anaemia
  2. Ltmphopanaeia
  3. Mild raised transaminase and bilirubin
  4. Blood culture and faeces culture.
22
Q

What is treatment for enteric fever ?

A

IT IS MULTI DRUG RESISTANT INCL PENICLILLIN.

usually treated with ceftiaxone ( a cephalosporin )

There is some ceftriaxone resistance seen in Pakistan.

23
Q

How to prevent enteric fever ?

A
  1. Food and water hygenine precautions

2. typhoid vaccine ( although this is not 100% protection )

24
Q

What is dengue fever ?

A

Caused by the dengue virus,. The virus has 4 strains which are usually transmitted by mosquitos.

25
Q

Around 4-10 days after the bite by mosquito in dengue fever , what will patient present with ?

A
  1. Intense headache
  2. Fever
  3. Muscle / joint pain
  4. Widespread red rash

Sometimes asymptomatic

26
Q

How to treat dengue fever ?

A

There is NO specific treatment for dengue fever.

It resolves itself within a few days - Improves 3-4 days after presented with rash.

27
Q

What are consequences of dengue fever .?

A

In 1-2% of infections , there is progression to severe dengue or dengue haemorrhage fever which can be fatal. This can also happen if you have re-current dengue fever

This has no cure.

Patients presented with restlessness , acute or sudden fever , severe abdominal pain , bleeding or bruising under skin , nosebleeds , large decreases in blood pressure. Also associated with low levels of platlets in the blood.

28
Q

What is Ebola ?

A

Viral haemorrhage fever

Flu like illness with vomiting , diarrhoea headaches confusions rash. Includes internal and external bleeding at 5-7 days. Spread by direct contain with body fluids.

High fatality rate ( more than 50%)

29
Q

What is schistosomiasis?

A

A disease caused by parasitic flatworms called schistosomes.

Humans acquire the flatworms through unprotected skin contact areas of fresh water contaminated with the helminths which have been released from snails.

30
Q

What are symptoms of acute schistosomiasis?

A

Fever

Diarrhoea

Coughs

Rashes

Abdominal pain

Muscle and joint pain

31
Q

What are symptoms of chronic schistosomiasis?

A

Damaged the host immune response

Conditions include anaemia , cystitis , cardiovascular and respiratory problems. And neurological symptoms such as seizures and dizziness.

32
Q

How is diagnosis confirmed for schistosomiasis?

A

Confirmed by finding eggs in urine or stool sample or by a blood test for antibodies

33
Q

Why is acute schistosomiasis treated ?

A

Steroids to reduce inflammation

34
Q

What is the curative treatment for schistosomiasis?

A

Praziquantel- but this is most effective once the worms have matured so a patient might find they aren’t given treatment until a number of weeks post infection.

35
Q

What is legionellosis??

A

Caused by legionella bacteria ( gram negative)

The most serious conditional legionella can cause is legionnaires disease.

36
Q

Where are you likely to acquire legionella bacteria ?

A

The most likely place is somewhere where the water is at a high temperature to help the bacteria to grow - somewhere like a poorly maintained shower system or air conditioning unit. Or hot tub. Also rivers and lakes.

37
Q

Mechanism of action of legionella bacteria

A

Contracted by inhaling drop,ets of water that bacteria are contained in.

Once inside the body , L.pneumophillia invades macrophages in the lungs and replicates inside them.

38
Q

Incubation period pf legionella bacteria

A

2-10 days after exposure

39
Q

Acute symptoms of legionnaires disease

A

Headache

Muscle / chest pain

Chills

Fever that may be 40 degrees or higher

Infection (24 decks)

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